Search

Purpose Disordered eating and body image concerns are increasingly common among adolescents, possibly representing the underpinning of eating disorders (EDs). This cross-sectional observational study aimed at investigating the relationship between various patterns of sports involvement or inactivity, and the abovementioned psychopathological dimensions. Methods All adolescents attending their 3rd–5th Italian grade in a single high school reported their sociodemographic and anthropometric data, their weekly sports involvement, and filled the Eating Disorders Examination Questionnaire 6.0 (EDE-Q), the Body Uneasiness Test, and the Muscle Dysmorphia Disorder Inventory (for boys). Comparisons were performed considering sex, weekly hours of activity, and different sports type (none, individual, or team sports). Results Of 744 enrolled students, 522 (70.2%) completed the survey. Girls showed higher underweight rates, preference for inactivity or individual sports, and higher psychometric scores compared to boys. Among girls, no differences were found based on time spent exercising or sports type. Inactive boys displayed worse weight- and shape-based psychopathology, higher body uneasiness, and higher appearance intolerance compared to those who devoted more time to exercise. Among boys, individual and team sports were associated with lower EDE-Q scores compared to inactivity, whereas body uneasiness and appearance intolerance were lower only in team sports. Conclusions The study confirms the presence of remarkable sex differences in eating and body concerns of adolescents. Among boys, sports involvement is tied to lower ED psychopathology, and preference for team sports may be associated with reduced concerns. Wider longitudinal studies on will clarify the direction and specificity of these findings. Level of evidence Level V—Cross-sectional observational study.

Structural health monitoring is effective if it allows us to identify the condition state of a structure with an appropriate level of confidence. The estimation of the uncertainty of the condition state is relatively straightforward a posteriori, i.e., when monitoring data are available. However, monitoring observations are not available when designing a monitoring system; therefore, the expected uncertainty must be estimated beforehand. This paper proposes a framework to evaluate the effectiveness of a monitoring system accounting for temperature compensation. This method is applied to the design process of a structural health monitoring system for civil infrastructure. In particular, the focus is on the condition-state parameters representing the structural long-term response trend, e.g., due to creep and shrinkage effects, and the tension losses in prestressed concrete bridges. The result is a simple-to-use equation that estimates the expected uncertainty of a long-term response trend of temperature-compensated response measurements in the design phase. The equation shows that the condition-state uncertainty is affected by the measurement and model uncertainties, the start date and duration of the monitoring activity, and the sampling frequency. We validated our approach on a real-life case study: the Colle Isarco viaduct. We verified whether the pre-posterior estimation of expected uncertainty, performed with the experimented approach, is consistent with the real uncertainty estimated a posteriori based on the monitoring data.

A series of dedicated lower hybrid current drive (LHCD) experiments on EAST shows that lithium wall conditioning extends LH current drive and heating up to the line-averaged density of n - e ≈ 4x1019 m−3 for both 2.45 and 4.6 GHz. Current drive at such a high density is crucial for the development of long-pulse non-inductive scenarios on EAST. With lithiation, the LH power injection of 1.5 MW at 2.45 GHz resulted in a drop of loop voltage of ~ 0.3 V, which is a comparable loop voltage drop observed with 1.1 MW at 4.6 GHz. The observed decrease in loop voltage is attributed mostly to the RF heating effect. Another LHCD experiment suggests that lithium wall coating has a more significant impact on the scrape-off-layer (SOL) properties than changes in the Greenwald fraction. LHCD at 2.45 GHz still suffers from a loss of efficiency. Enhanced power ionization in front of the launcher may cause the onset of density-dependent wave instabilities. The rise in the midplane SOL density may also accelerate a transition in the divertor regime, leading to additional ionization and collisional losses in the X-point divertor plasma. Ray-tracing modeling supports that a lower wave frequency is more prone to collisional power loss. The experiments confirm that lithiation is a useful tool to control the SOL plasma, and suggest that density control in front of the launcher may be critical to mitigating power loss mechanisms in the plasma boundary.

Angiosarcoma of the thyroid is a rare and aggressive primary malignant tumour of the thyroid. We report the case of a 69-year-old woman who presented with a red and sore skin area at the right-anterior region of the neck. Ultrasound examination and computed tomography scan showed a non-homogeneous mass in the right thyroid lobe. Fine needle aspiration cytology was suggestive of atypical vascular proliferation and so the patient underwent right thyroid lobectomy. The specimen measured 6 × 5 × 2.5 cm, and a reddish nodule was found, including a whitish central area of maximum 4 cm in diameter. Immunohistochemistry showed CD31 and ERG positivity, while thyroglobulin, calcitonin and TTF-1 expression were negative, indicating a diagnosis of angiosarcoma.

The EAST tokamak relies on Lower Hybrid (LH) heating and current drive for long pulse steady-state operation [1]. The combination of the two antennas—operating at 2.45 and 4.6 GHz—offers a unique opportunity to understand the synergy between LH waves and how to best exploit it for optimization of plasma performance towards demonstration of sustained steady-state. Because the DC electric field affects the fast electron distribution function, it is important that the magnetic equilibrium and the LH current drive are evolved self-consistently [2]. For this reason, time-dependent modeling is a necessary tool to guide experiments on EAST dedicated to access and sustainment of steady-state.The time-dependent evolution of an EAST plasma discharge with lower hybrid power has been modelled using the TRANSP code in combination with GENRAY and CQL3D. Analytical profiles for electron temperature and density were fitted to the measured profiles to remove noise from experimental measurements, as well as for ease of scaling studies. This enables quick scans of density to identify an optimal range for high LH current drive and maximum plasma performance. Preliminary results from scaling studies suggest there is a density threshold, beyond which current drive is significantly reduced. Additionally, there is some indication that the electron heating and the driven current do not scale similarly with density and temperature, indicating a complex nonlinearity in the absorption process. Future work will address the current challenges in time-dependent LH simulations and explore the synergy between the two LH antennas during simultaneous power injection.

The ITER Research Plan envision operation around half of the nominal magnetic field (i.e. around B = 2.65 T) as a path to baseline operation. This work discusses constraints on the optimal range of magnetic field, which is bounded in the lower limit by the presence of the third-harmonic electron cyclotron resonance at half field, and on the upper limit by the loss of core heating and current drive. It will be shown that increasing the magnetic field by only 3%, i.e. to 2.75 T, eliminates the third harmonic parasitic absorption without compromising demonstration of access to H-mode, while operating at a magnetic field of 3.0 T - previously proposed for optimal use of the ion cyclotron system - would impair the use of the electron cyclotron system for core-heating and current drive. Operation at 2.65 T would still be possible if the polarization of the equatorial launcher is changed from X-mode to O-mode in the current flattop phase.

Synergistic effects between two frequencies of lower hybrid (LH) waves—operating at 2.45 and 4.6 GHz—were observed in experiment on EAST for the first time. At low density ( n e , lin ≈ 2.0 × 1 0 19 m − 3), simultaneous injection of a 65/35 mix of 2.45/4.6 GHz power achieved an lower hybrid current drive efficiency that was 25% higher than what should be expected from the linear combination of the two sources. The experiment was interpreted with time-dependent simulations, using the equilibrium and transport solver TRANSP, coupled with the ray-tracing code GENRAY and the Fokker–Planck solver CQL3D. For each discharge, profiles of current and hard x-rays from simulation and measurement agree within uncertainties. An examination of the electron distribution function indicates that the LH synergy is supported by the increased width of the LH resonance plateau in the simultaneous injection case compared to independent injection.

Background Pleomorphic and Florid Lobular carcinoma in situ (P/F LCIS) are rare variants of LCIS, the exact nature of which is still debated. Aim To collect a large series of P/F LCIS diagnosed on preoperative biopsies and evaluate their association with invasive carcinoma and high grade duct carcinoma in situ (DCIS). Data obtained were compared with those reported in the literature. Methods A multi-institutional series of P/F LCIS was retrieved. All cases were diagnosed on pre-operative biopsies, which was followed by an open surgical excision. Data on post-operative histopathology were available. A literature review was performed. Results A total of 117 cases were collected; invasive carcinoma and/or DCIS was present in 78/117 cases (66.7%). Seventy cases of P/F LCIS were pure on biopsy and 31 of these showed pathological upgrade in post-surgical specimens. Pre-operative biopsy accuracy was 47/78 (60.3%); pre-operative biopsy underestimation of cancer was 31/78 (39,7.%). In the literature review papers, invasive carcinoma or DCIS was associated with 274 of 418 (65.5%) cases of P/F LCIS. Pre-operative biopsy accuracy was 66% (181/274) whereas pre-operative biopsy underestimation of cancer was 33.9% (93/274). Conclusions The data presented here indicate that P/F LCIS is frequently associated with invasive carcinoma or high grade DCIS and that pre-operative biopsy is associated with an underestimation of malignancy. Open surgery is indicated when P/F LCIS is diagnosed pre-operatively.

We report results of benchmarking of core particle transport simulations by a collection of codes widely used in transport modelling of tokamak plasmas. Our analysis includes formulation of transport equations, difference between electron and ion solvers, comparison of modules of the pellet and edge gas fuelling on the ITER baseline scenario. During the first phase of benchmarking we address the particle transport effects in the stationary phase. Firstly, simulations are performed with identical sources, sinks, transport coefficients, and boundary conditions prescribed in the flattop H-mode phase. The transformation of ion particle transport equations is introduced so to directly compare their results to electron transport solvers. Secondly, the pellet fuelling models are benchmarked in various conditions to evaluate the dependency of the pellet deposition on the pellet volume, injection side, pedestal, and separatrix parameters. Thirdly, edge gas fuelling is benchmarked to assess sensitivities of source profile predictions to uncertainties in plasma conditions and detailed model assumptions. At the second phase, we address particle transport effects in the time- evolving plasma including the current ramp-up to the ramp-down phase. The ion and the electron solvers are benchmarked together. Differences between the simulation results of the solvers are investigated in terms of equilibrium, grid resolution, radial coordinate, radial grid distribution, and plasma volume evolution term. We found that the selection of the radial coordinate can yield prominent differences between the solvers mainly due to differences in the edge grid distribution. The simulations reveal that electron and ion solvers predict noticeably different density peaking for the same diffusion and pinch velocity while with the peaked profile of helium, expected in fusion reactors. The fuelling benchmarking shows that gas puffing is not efficient for core fuelling in H-modes and density control should be done by the high field side pellet injection in contrast to present machines.

Pedestal collapse (i.e., the complete loss of the edge transport barrier (ETB)) in DIII-D H-mode plasmas occurs when resonant magnetic perturbations (RMPs) penetrate the steep gradient region at the plasma edge. Normally, RMP driven magnetic islands can occur at the top and bottom of the H-mode pedestal and these islands generate conditions consistent with edge-localized-mode (ELM) suppression and density pump-out, respectively, based on nonlinear two-fluid MHD simulations. In contrast, MHD simulations show that the steep pressure gradient region between the top and bottom of the DIII-D pedestal is generally immune to resonant field penetration due to large local E × B and diamagnetic flows. By this fortuitous circumstance, the edge-transport-barrier and H-mode confinement can be maintained while achieving ELM suppression. However, pedestal collapse can occur in DIII-D when the screening flows are inadequate to prevent field penetration in the steep gradient region of the pedestal. Non-linear two-fluid MHD simulations support the role of resonant field penetration in pedestal collapse for DIII-D H-mode plasmas with weak edge E × B and diamagnetic screening flows. ITER will likely have weaker edge screening flows than present experiments due to its much larger size, making it more susceptible to resonant field penetration in the steep gradient region of the pedestal. Analysis of model ITER equilibria demonstrates that resonant field penetration in the steep pressure gradient region is possible for RMP levels of the order required for ELM suppression. The effect of such penetration on the ITER pedestal will depend sensitively on the resulting degree of island overlap.

Introduction The interest in health-related quality of life (HR-QoL) has increased in the past few years. Aim The aim of this study was to evaluate the HR-QoL before and after transplantation in solid organ recipients referred to the North Italy Transplant program. Material and Methods This cross-sectional study was performed between 2010 and 2011. All consecutive recipients on the waiting list for liver, heart, or kidney transplantation were included and compared to all consecutive transplanted patients at 6 and 24 months of follow-up after transplantation. The HR-QoL was evaluated with the 36-item Short Form Health Survey (SF–36) and the Profile of Mood States (POMS). Questionnaires were self-reported anonymously. Descriptive statistical analyses were performed. Results Four hundred eleven patients were interviewed: 146 patients (35.5%) were on the waiting list, 137 (33.3%) were transplanted 6 months before the interview, and 128 (31.1%) were transplanted 24 months before the interview. Patients on the waiting list had a lower SF–36 score for all items than did transplanted patients after both 6 and 24 months. According to POMS results, patients on the waiting list had a higher prevalence of depression, tension, anger, fatigue, and confusion than did transplanted patients. Conclusions Patients on the waiting list showed a worse quality of life compared to patients after transplantation as demonstrated by SF–36 and POMS results. These findings should be confirmed in a cohort study.

This multicenter case-controlled pilot study evaluated myocardial inflammatory burden (IB) and phenotype in endomyocardial biopsies (EMBs) with and without pathologic antibody-mediated rejection (pAMR). Sixty-five EMBs from five European heart transplant centers were centrally reviewed as positive (grade 2, n = 28), suspicious (grade 1, n = 7) or negative (n = 30) for pAMR. Absolute counts of total, intravascular (IV) and extravascular (EV) immunophenotyped mononuclear cells were correlated with pAMR grade, capillary C4d deposition, donor specific antibody (DSA) status and acute cellular rejection (ACR). In pAMR+ biopsies, equivalent number of IV CD3+ T lymphocytes (23 ± 4/0.225 mm(2) ) and CD68+ macrophages (21 ± 4/0.225 mm(2) ) were seen. IB and cell phenotype correlated with pAMR grade, C4d positivity and DSA positivity (p < 0.0001). High numbers of IV T lymphocytes were associated with low grade ACR (p = 0.002). In late-occurring AMR EV plasma cells occurring in 34% of pAMR+ EMBs were associated with higher IB. The IB in AMR correlated with pAMR+, C4d positivity and DSA positivity. In pAMR+ equivalent numbers of IV T lymphocytes and macrophages were found. The presence of plasma cells was associated with a higher IB and occurrence of pAMR late after transplantation.

The advanced physics and advanced technology tokamak power plant ARIES-ACT1 has a major radius of 6.25 m at an aspect ratio of 4.0, toroidal field of 6.0 T, strong shaping with elongation of 2.2, a...

Tokamak power plants are studied with advanced and conservative design philosophies to identify the impacts on the resulting designs and to provide guidance to critical research needs. Incorporating updated physics understanding and using more sophisticated engineering and physics analysis, the tokamak configurations have developed a more credible basis compared with older studies. The advanced configuration assumes a self-cooled lead lithium blanket concept with SiC composite structural material with 58% thermal conversion efficiency. This plasma has a major radius of 6.25 m, a toroidal field of 6.0 T, a q95 of 4.5,a βtotal N of 5.75, an H98 of 1.65, an n/nGr of 1.0, and a peak divertor heat flux of 13.7 MW/m2. The conservative configuration assumes a dual-coolant lead lithium blanket concept with reduced-activation ferritic martensitic steel structural material and helium coolant, achieving a thermal conversion efficiency of 45%. The plasma has a major radius of 9.75 m, a toroidal field of 8.75 ...

The conservative physics and conservative technology tokamak power plant ARIES-ACT2 has a major radius of 9.75 m at an aspect ratio of 4.0 and has strong shaping with elongation of 2.2 and triangul...

The lower hybrid current drive (LHCD) system on Alcator C-Mod is capable of sustaining fully non-inductive discharges for multiple current relaxation times (τ cr ∼ 200 ms) at line averaged densities in the range of 5x10 19 m -3 . Some of these non-inductive discharges develop unstable MHD modes that can greatly reduce current drive performance, particularly in discharges with plasma current of 0.5 MA or less [1,2]. Avoiding these unstable MHD modes motivated an experiment to test if the stable current profile shape of a higher current non-inductive discharge could be achieved in a lower current discharge. Starting from a discharge at 0.8 MA, the plasma current was ramped down to 0.5 MA over 200 ms. The surface voltage of the plasma swings negative during the ramp, with the loop voltage reversal impacting the edge fast electron measurements immediately. Little change can be seen during the I p ramp in the core fast electron measurements, indicating that the loop voltage reversal does not penetrate fully to the magnetic axis on the timescale of the current ramp. The resulting discharge did not exhibit deleterious MHD instabilities, however the existence of this one discharge does not necessarily represent a robust solution to the problem., United States. Department of Energy. Office of Fusion Energy Sciences (Award DE-FC02-99ER54512), United States. Department of Energy. Office of Fusion Energy Sciences (Award DE-AC02-76CH03073)

Fusion whole device modeling simulations require comprehensive models that are simultaneously physically accurate, fast, robust, and predictive. In this paper we describe the development of two neural-network (NN) based models as a means to perform a snon-linear multivariate regression of theory-based models for the core turbulent transport fluxes, and the pedestal structure. Specifically, we find that a NN-based approach can be used to consistently reproduce the results of the TGLF and EPED1 theory-based models over a broad range of plasma regimes, and with a computational speedup of several orders of magnitudes. These models are then integrated into a predictive workflow that allows prediction with self-consistent core-pedestal coupling of the kinetic profiles within the last closed flux surface of the plasma. The NN paradigm is capable of breaking the speed-accuracy trade-off that is expected of traditional numerical physics models, and can provide the missing link towards self-consistent coupled core-pedestal whole device modeling simulations that are physically accurate and yet take only seconds to run.

Within the framework of the EU-funded HLA-NET action, an analysis of three G-group alleles, HLA-B*44:02:01G, DRB1*14:01:01G and DQB1*03:01:01G, was undertaken in 12 European populations. Ambiguities were resolved by polymerase chain reaction-sequence-specific amplification (PCR-SSP) or PCR-sequence-based typing (PCR-SBT) in a total of 5095 individuals. The results of the DRB1*14:01/14:54 ambiguity showed high relative ratios (24–53%) of DRB1*14:01 in Bulgarians, Croatians, Greeks, Italians and Slovenians, contrasting with low ratios (6–13%) in Austrians, Finnish, French, Hungarians, Norwegians and Swiss. Resolution of the B*44:02/44:27 ambiguity showed that B*44:27 had a high relative ratio in Slovenians (25.5%) and Bulgarians (37%) and low in French and Swiss (0.02–1%), and was not observed in Greeks and Italians. The highest relative ratio of DQB1*03:19 was found in Portuguese (11%), by contrast with low ratios (0–3%) in the other five populations. Analysis of the A, B, DRB1 phenotypes and family-derived haplotypes in 1719 and 403 individuals positive for either HLA-B*44:02G or DRB1*14:01G ambiguities, respectively, showed some preferential associations, such as A*26∼DRB1*14:01, B*35∼DRB1*14:01, B*38∼DRB1*14:01 and B*44:27∼DRB1*16. Because these ambiguities are located outside the peptide-binding site, they may not be recognized by alloreactive T-cells. However, because of strong linkage disequilibrium (LD), the DRB1*14:01 vs DRB1*14:54 and the B*44:02 vs B*44:27 mismatches are associated to DRB3-, and C-mismatches, respectively. These results are informative for algorithms searching unrelated hematopoietic stem cell donors. For B*44:27-positive patients, searches are expected to be more successful when requesting donors from Southeastern-European ancestry. Furthermore, the introduction of human leukocyte antigen (HLA)-typing strategies that allow resolving exon 4 (for class I) and exon 3 (for class II) polymorphisms can be expected to contribute significantly to population genetics studies.

Objective We aimed to report the clinical picture of two asymptomatic daughters of a patient with autosomal dominant cerebellar ataxia, deafness, and narcolepsy (ADCA-DN) due to a mutation in the DNA (cytosine-5-)-methyltransferase gene, DNMT1 . Methods Clinical assessment based on history, neurologic examination, sleep recordings, neurophysiologic neuroimaging, and genetic tests was performed. Results History and neurologic examination in both subjects were unremarkable. Genetic analysis disclosed in both the paternally-inherited heterozygous point mutation in the DNMT1 gene. Sleep recordings found sleep-onset rapid eye movement periods (SOREMPs) and proton magnetic resonance spectroscopy (MRS) revealed increased cerebellar myoinositol (mI) in both subjects. Auditory and ophthalmologic investigations as well as structural brain magnetic resonance imaging (MRI) scans revealed no abnormalities. Conclusions The two asymptomatic carriers of the heterozygous DNMT1 mutation for ADCA-DN, a late-onset neurodegenerative disease, presented with SOREMPs associated with an increase of mI in the brain, a marker of glial cell activity and density characteristic of early stages of neurodegenerative diseases. Therefore, SOREMPs may precede the clinical picture of ADCA-DN as an early polysomnographic marker of central nervous system involvement detected by MRS.

Long-term clinical outcome of islet transplantation is hampered by the rejection and recurrence of autoimmunity. Accurate monitoring may allow for early detection and treatment of these potentially compromising immune events. Islet transplant outcome was analyzed in 59 consecutive pancreatic islet recipients in whom baseline and de novo posttransplant autoantibodies (GAD antibody, insulinoma-associated protein 2 antigen, zinc transporter type 8 antigen) and donor-specific alloantibodies (DSA) were quantified. Thirty-nine recipients (66%) showed DSA or autoantibody increases (de novo expression or titer increase) after islet transplantation. Recipients who had a posttransplant antibody increase showed similar initial performance but significantly lower graft survival than patients without an increase (islet autoantibodies P < 0.001, DSA P < 0.001). Posttransplant DSA or autoantibody increases were associated with HLA-DR mismatches (P = 0.008), induction with antithymocyte globulin (P = 0.0001), and pretransplant panel reactive alloantibody >15% in either class I or class II (P = 0.024) as independent risk factors and with rapamycin as protective (P = 0.006) against antibody increases. DSA or autoantibody increases after islet transplantation are important prognostic markers, and their identification could potentially lead to improved islet cell transplant outcomes.

SUMMARY In the diagnostic work-up of hypersomnias of central origin, the complaint of excessive daytime sleepiness should be objectively confirmed by MSLT findings. Indeed, the features and diagnostic utility of spontaneous daytime sleep at 24 h continuous polysomnography (PSG) have never been investigated. We compared daytime PSG features to MSLT data in 98 consecutive patients presenting with excessive daytime sleepiness and with a final diagnosis of narcolepsy with cataplexy ⁄hypocretin deficiency (n = 39), narcolepsy without cataplexy (n = 7), idiopathic hypersomnia without long sleep time (n = 19), and hypersomnia with normal sleep latency at MSLT (n = 33). Daytime sleep time was significantly higher in narcolepsy-cataplexy but similar in the other groups. Receiver operating characteristics (ROC) curves showed that the number of naps during daytime PSG predicted a mean sleep latency £8 min at MSLT with an area under the curve of 0.67 ± 0.05 (P = 0.005). The number of daytime sleep-onset REM periods (SOREMPs) in spontaneous naps strikingly predicted the scheduled occurrence of two or more SOREMPs at MSLT, with an area under the ROC curve of 0.93 ± 0.03 (P

The development of solid-phase assays for antibody detection has aided in the frequent detection of human leukocyte antigen (HLA) antibodies in nonalloimmunized males. Some scientists have reported that these HLA antibodies are produced to pathogens or allergens and the reactivity with HLA coated beads is the result of cross-reactive epitopes. These antibodies may also be directed toward cryptic epitopes exposed on the denatured beads. In this report, we describe the case of a heart transplanted patient who exhibited anti-HLA-A*02:01 donor-specific antibodies detected with a bead-based assay (Luminex) and undetected with the complement-dependent cytotoxicity (CDC) test. Posttransplant monitoring, carried out with CDC and with Luminex on sera from this patient collected at the 2nd, 4th, 8th, and 12th posttransplant weeks and at 1 year confirmed the presence of anti-HLA-A*02:01 in all serum samples. Additional tests carried out with denatured and intact HLA molecules using single antigen beads demonstrated that the antibody was directed toward a cryptic epitope. One year after transplantation the patient is doing well. No sign of antibody-mediated rejection was observed throughout the follow-up. A comprehensive evaluation of the anamnesis and of antibodies is critical to avoid needless exclusion of organ donors.

Summary We compared periodic and non-periodic leg movements during sleep and polysomnography in patients with narcolepsy with cataplexy (NC) with or without restless legs syndrome (RLS) with matched idiopathic RLS (iRLS) and control subjects. We enrolled 100 patients with NC: 17 having RLS were compared with 34 sex- and age-matched patients without RLS and with 17 normal controls and 17 iRLS subjects. Periodic leg movements were highest in iRLS and lowest in controls, with those in NC with RLS very close to iRLS, but higher than those in NC without RLS. The periodicity indexes showed the highest value in iRLS followed by NC with or without RLS and, finally, by controls. The inter-leg movement intervals peaked between 10 and 50 s in NC with RLS and in iRLS, the former did not display the nocturnal gradual decrease of periodic leg movements typical of iRLS. Periodic leg movements during sleep and polysomnography displayed specific features in RLS and NC, respectively, with NC with RLS showing an intermediate pattern. Even if RLS is only detected by targeted interview in NC, its frequency and impact on night-time sleep architecture and continuity suggest that this condition should be routinely searched for in NC.

Narcolepsy is a clinical condition characterized mainly by excessive sleepiness and cataplexy. Hypnagogic hallucinations and sleep paralysis complete the narcoleptic tetrad; disrupted night sleep, automatic behaviors and weight gain are also usual complaints. Different studies focus on autonomic changes or dysfunctions among narcoleptic patients, such as pupillary abnormalities, fainting spells, erectile dysfunction, night sweats, gastric problems, low body temperature, systemic hypotension, dry mouth, heart palpitations, headache and extremities dysthermia. Even if many studies lack sufficient standardization or their results have not been replicated, a non-secondary involvement of the autonomic nervous system in narcolepsy is strongly suggested, mainly by metabolic and cardiovascular findings. Furthermore, the recent discovery of a high risk for overweight and for metabolic syndrome in narcoleptic patients represents an important warning for clinicians in order to monitor and follow them up for their autonomic functions. We review here studies on autonomic functions and clinical disturbances in narcoleptic patients, trying to shed light on the possible contribute of alterations of the hypocretin system in autonomic pathophysiology.

Excessive daytime sleepiness (EDS) has different correlates in non-rapid eye movement (NREM) [idiopathic hypersomnia (IH) without long sleep time] and REM sleep [narcolepsy without cataplexy (NwoC) and narcolepsy with cataplexy (NC)]-related hypersomnias of central origin. We analysed sleep onset characteristics at the multiple sleep latency test (MSLT) applying simultaneously two sleep onset criteria in 44 NC, seven NwoC and 16 IH consecutive patients referred for subjective EDS complaint. Sleep latency (SL) at MSLT was assessed both as the time elapsed to the occurrence of a single epoch of sleep Stage 1 NREM (SL) and of unequivocal sleep [three sleep Stage 1 NREM epochs or any other sleep stage epoch, sustained SL (SusSL)]. Idiopathic hypersomnia patients showed significantly (P

BACKGROUND The aim of this study was to assess the significance of positive C4d capillary immunostaining of endomyocardial biopsies and its correlation to clinical outcome in adult heart transplant recipients. METHODS Nine hundred eighty-five endomyocardial biopsies from 107 heart transplant recipients were evaluated. Immunostaining for detection of intragraft C4d capillary deposition was performed on paraffin-embedded tissue using anti-human C4d polyclonal antibody. RESULTS Positive staining of C4d was present in 36 patients (34%) and antibody-mediated rejection in eight patients (7%). The patients were subdivided into four groups on the basis of their C4d, circulating antidonor antibodies (donor-specific antibodies [DSAs]), and graft function: group 1=C4d positive, DSA negative, and no graft dysfunction; group 2=C4d positive, DSA positive, and no graft dysfunction; group 3=C4d positive, DSA positive, and signs of graft dysfunction, and group 0 (control)=all negative. An higher mortality risk was found in C4d-positive patients, when compared with negative ones (unadjusted hazard ratios: group 1: 18, group 2: 61, and group 3: 32-fold risk; P